Healthcare Provider Details

I. General information

NPI: 1023795440
Provider Name (Legal Business Name): CYRUS JOYA TOLEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 MARINE CORPS DRIVE
SANTA RITA GU
96915
US

IV. Provider business mailing address

U.S. NAVAL HOSPITAL GUAM PSC 455
FPO AP
96540-1600
US

V. Phone/Fax

Practice location:
  • Phone: 671-339-3175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: